Medical Evidence for VA Claims

11-29-2008, 01:57 PM

A claim for disability benefits can live or die on one medical opinion. In many cases, the VA will rely on findings from Compensation & Pension physicians to reach a decision. However, a disconnect all too often exists between what the veteran expects and what he or she gets. Outcome: claim denied.

So what makes a medical opinion worth the paper that it is written on? Before answering, let me explain what the VA does not consider competent, or expert derived, medical evidence. First, unless your spouse happens to be a physician, he or she cannot answer questions of causation or diagnosis, even if he or she is intimately familiar with your condition. And your cousin who is a dentist cannot provide expert analysis of your heart condition by virtue of his familiarity with a field of medicine. Even a general practitioner’s opinion can often be eclipsed by the findings of a VA expert in a particular field. In order for a medical opinion to matter, it must be both credible and probative.

An opinion is considered credible only if it comes from an expert or, better yet, a qualified source among experts. After clearing that hurdle, it must also be probative, or relevant, to the issue that it addresses. For example, a statement from a neurologist who has reviewed a veteran’s medical history and examined the veteran to arrive at a medical opinion about nerve loss is considered highly persuasive. That is, her opinion is said to be credible and probative.

Sometimes, two medical opinions will arrive at opposing conclusions, and a VA rating specialist must assign weight to each. As mentioned earlier, the best opinions come from physicians who specialize in the medical field surrounding the disability in question. Other important aspects influencing weight include whether the physician reviewed prior clinical records, the physician’s familiarity with the veteran, the degree of specificity and certainty noted in the opinion, and whether the physician’s contact with the veteran was for treatment or substantiation of a claim. Note that an opinion may be overlooked altogether if it materially relies on the veteran’s unsupported history as a premise for the rationale. Also, most importantly, the information contained in the veteran’s claims folder must support the medical conclusion.

I will end with a quick discussion on evidentiary standard. A veteran must prove a claim based on a “preponderance of the evidence.” This means that the evidence as a whole must lean in favor of the veteran by 51 percent or greater, often quantified in a medical opinion by the term “more likely than not.” In many cases, the hardest part about adequately proving a claim is getting the physician to write a favorable opinion when the answers are not very clear. In the end, your claim may only be as good as the opinion on which it is based. ☺

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If I show up in a chair with quad hands, I reckon the visual alone is going to say a thousand words....but I guess never count on anything right?

That is the truth. Never count on anything being taken for granted. If you are claiming a service connection you must still show a nexus. There must be a record showing the injury occurred in the time and manner you claim it did. The record can come from private physicians/hospitals, or military dod sources.

I was lucky enough to have records found from 35 years ago in a military hospital that showed a clear enough nexus to get me 70% dis., no appeals or questions. I had to provide the information, though. A person making a claim must do their homework and collect all the applicable data to go along with their 'visual aids".

Anything worth doing, is worth doing to excess

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Mike, a serious disability like a SCI would be enough for a VA physician to examine you and complete the paperwork for Category 4 priority eligibility, but that would not get you service connection. For that you would need to have evidence that the injury occurred while you were on active duty or was caused by a condition that you developed while you were active duty, and it was "in the line of duty" (not due to willful misconduct, for example). If you are seriously disabled, and served during wartime, and are low income, you may also qualify for a VA pension.

(KLD)

The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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Mike, a serious disability like a SCI would be enough for a VA physician to examine you and complete the paperwork for Category 4 priority eligibility, but that would not get you service connection. For that you would need to have evidence that the injury occurred while you were on active duty or was caused by a condition that you developed while you were active duty, and it was "in the line of duty" (not due to willful misconduct, for example). If you are seriously disabled, and served during wartime, and are low income, you may also qualify for a VA pension.

(KLD)

Hi SCI Nurse, First, I would like to thank you for all the information and support you provide!!! Second, please know that I do not mean to contradict what you just wrote by any means. You are correct for the most part. However, I have a close friend who had thyroid cancer. It was removed and this person made a full recovery. After fulfilling the 4 year state side commitment this person got out and now holds a full time job on post as a civilian. Keep in mind, this person would have had this regardless if they had been in the military or not. They ended up getting 60% disability, a monthly VA tax free pension for the rest of their life, a free bachelors degree - along with extra monthly income just to go to school based on the # of dependents and will also get a free Masters. Not sure how this was service connected....While it is nice this person was able to get all this and is utilizing all the benefits that have been offered, I am bothered when I hear of a service member who suffered injuries while fighting for our country and has to fight the government to get to get the help they need. Anyway, I guess my point is that there are cases when a VA disability is not always service connected.

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I guess my point is that there are cases when a VA disability is not always service connected.

You are right. You can have NSC (non-service connected) disability, which means that it did not occur during your service, nor was it caused by a condition that occurred during your service, OR you can have a SC (connected disability) which means that it occurred during service or was caused by a condition that occurred during service. Both are disabled veterans, with VA benefits, although of different types and amounts of benefits when it comes to non-medical benefits (ie, pension, vocational rehab, etc. etc.)

I am not sure I understand your point. If your friend was rated as 60% service connected, then that is the amount of disability he was rated for by the VA for his thyroid cancer. Because it occurred while he was in the service, it would be considered a service connected condition. How do you know it was not associated with his service, and what difference does this make??

And how does this slight the veteran who served in war-time?? I can tell you that now days the VA bends over backwards to get our OEF/OIF veterans the benefits and care they are entitled to. I am sad to say that this NOT always the case with the DOD (Army, Navy, Marines, Air Force or Coast Guard). Keep in mind that the VA is NOT part of the DOD but is a totally separate part of the executive branch of our government.

(KLD)

The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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I have a close friend who had thyroid cancer. It was removed and this person made a full recovery. After fulfilling the 4 year state side commitment this person got out and now holds a full time job on post as a civilian. Keep in mind, this person would have had this regardless if they had been in the military or not. They ended up getting 60% disability, a monthly VA tax free pension for the rest of their life, a free bachelors degree - along with extra monthly income just to go to school based on the # of dependents and will also get a free Masters. Not sure how this was service connected.

Your friend may have been compensated under the presumptive service connection concept. Some conditions like cancer are considered incidental to service after years of testing/validating the dangers of exposure to certain hazards. Agent Orange (Vietnam) and asbestos (on Navy ships) are the most prevalent presumptive claims filed in my experience (and the easiest to win!). You're right where you say they might've gotten the disease regardless of service, but statute---not Mother Nature---decides in these cases.

Other conditions include diabetes, MS, ALS, and many other forms of cancer.

Gunner

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Movign and putting things in storage, and visiting several VA resources I CANNOT find my Navy Medical Records (Volume One and Volume Two/ OF Two) Now what do I do? I don't know IF the VA in Topeka has them, or once again the KCMO Va Hospital has them, OR worse yet if my copies are stored in my storage lockers. IS there any source for my Medical Records so that I could Order them? I'm rated at 60% VA Disability and 100% SSDI (Federal Court in KC, KS) but my back injuries that gave me my SSDI are service Connected and I can prove that with my Medical Records showing the initial accident and problems throught my entire Navy 20 years inclusinve of back schools, and many visits for swollen back and even treatments using heat and ice. Too, I failed my last 2 re-enlistment Physicals in AUdiology, the VA actually made me a Hearing Aid, but they now claim thath they never gave me one and after THREE trips all the way over to MO for Audiology Appointments each one marked "INCONCLUSIVE" I refuse to make another trip to KCMO VA Hospital ever again. I don't midn driving the distance to Topeka, KS or even Denver, CO as long as I don't have to visit the nasty VA Hospital in KCMO again.
I thank you for your time and reply reguarding this inquiry.

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You can get copies of your records under the Freedom of Information Act. Just stop by the records desk at the VAMC and fill out the form for them. It can take several months . Alternatively, you can request a copy of your C-file from your VARO which would then be routed to the appropriate facility. They may have to come from St Louis which takes some time.

Anything worth doing, is worth doing to excess

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Thank you very much. I cannot believe that I let my Medical Records get packed up. I was certain that I had them in my Brief case...but I didn't. My Service Record was there, my DD214's etc...I'll get them Ordered; and Thank you Skippy!
Lindsey "Kansas" Angell

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I've been going through my service records and have noticed alot of stuff missing that should be there. Such as visits to sick bay due to falls off of birds, a report to my command concerning a incident that was reported up the chain of command and to sick bay. How do I find those missing records and get my records corrected. I do not know if that will play a part in getting some of my issues claimed as service connected

I miss my birds and being able to run! Syrinx's at T2-T6 and T9-T10 prominence of CC at T7-8 DDD at T6-7,T7-7 and T8-9, fusion at C5,6,7, in other words totally screwed up lol

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Your PVA (or other Veterans' organization) National Service Officer can help you find resources like this. Unfortunately DoD medical records are notoriously incomplete, and many times have been lost (they only went electronic, and even then, only partially, in the last couple of years).

Are you in touch with anyone you served with who could do an affidavit testifying to what they know/remember about any injuries or visits to sick bay you had? Sometimes it comes down to this due to total lack of official records.

Again, if your current NSO is not helping with this, you may want to consider changing your NSO agent for helping you with your eligiblity issues to the one from the PVA. Most of them are VERY aggressive in helping their members get such documentation.

(KLD)

The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.

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I think i am going to look into PVA tomorrow. My VSO is not and has not helped with jack shit yet. I am sick and tired of it. Only one that i'm in contact with who i served with is my old Chief, I'll talk to her to tomorrow. I was afraid of the incomplete records issue would be hard to over come
Thank you

I miss my birds and being able to run! Syrinx's at T2-T6 and T9-T10 prominence of CC at T7-8 DDD at T6-7,T7-7 and T8-9, fusion at C5,6,7, in other words totally screwed up lol

The SCI-Nurses are advanced practice nurses specializing in SCI/D care. They are available to answer questions, provide education, and make suggestions which you should always discuss with your physician/primary health care provider before implementing. Medical diagnosis is not provided, nor do the SCI-Nurses provide nursing or medical care through their responses on the CareCure forums.